Introduction:

 Hormonal replacement therapy is any form of hormonal therapy of a patients

who is in course of medical treatment receives hormone either for supplement of
naturally occurring hormones or to substitute other hormone for naturally
occurring hormones.

 Common forms of hormone replacement therapy.

 For menopause
 Androgen replacement therapy for male

• Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT)
or postmenopausal hormone therapy (PHT, PMHT), is a form of hormone therapy used to
treat symptoms associated with female menopause. Hormone replacement therapy is used
to help balance oestrogen and progesterone in women around the time of menopause.
Hormone replacement therapy (HRT) can help relieve sweating, hot flashes, and other
symptoms of menopause. It can also reduce the risk of osteoporosis. Some types of HRT
contain both progesterone and oestrogen, some only oestrogen, and sometimes testosterone
is used. Hormone replacement treatments are also used in male hormonal therapy and
treatment for individuals who undergo a sex change.

Uses

o Perimenopause: For some time, a woman will continue to menstruate, although

the changes are happening. This is called perimenopause. It can last from 3 to 10
years. Average duration is 4 years.
o Menopause: When the last period occurs, at an average age of 51 years, the woman
is in menopause.
o Post menopause: One full year after the last period, menopause ends, and the
woman enters the postmenopausal stage. Symptoms normally decline within 2 to 5
years, but it can take 10 years or more. The increased risk of osteoporosis continues
 after menopause. Apart from the natural aging process, menopause can be triggered
by a hysterectomy that includes removal of the ovaries, or cancer treatment.
Smoking can also speed up the arrival of menopause.

Types of HRT in women

Common types of HRT use different combinations and delivery of the hormones.
• Estrogen-only HRT: Women who have had a hysterectomy where their uterus, or womb, and
ovaries have been removed do not need progesterone.
• Cyclical or sequential HRT: Women who are still menstruating but have perimenopausal like
symptoms can use this. Cycles may be monthly, with an oestrogen plus progesterone dose at the
end of the menstrual cycle for 14 days, or a daily dose of oestrogen and progesterone for 14 days
every 13 weeks.
• Continuous HRT: This is used during postmenopausal. The patient takes a continuous
combination of oestrogen and progesterone.

• Local oestrogen: This includes vaginal tablets, creams, or rings. It can help with urogenital
problems, including dry vagina and irritations.

Hormone Replacement Therapy for Men

• Because men do not go through a well-defined period referred to as menopause, some doctors
refer to this problem as androgen (testosterone) decline in the aging male -- or low testosterone.

• Indication for HRT in male:

• Fatigue
• Weakness
• Depression
• Sexual problems.
Types of hormone therapy for men

Intramuscular testosterone injections: inject these into the muscles of buttocks every two to
three weeks.
• Testosterone patches: apply these each day to back, arms, buttocks, or abdomen. Be sure to
rotate the application sites.
• Topical testosterone gel: apply this each day to shoulders, arms, or abdomen.

Testosterone is required for:

• male sexual development

• reproductive function

• building muscle bulk

• maintaining healthy levels of red blood cells

• maintaining bone density

• However, the natural decrease of this hormone in men typically doesn’t affect overall
health any more than the aging process does.

Ways of delivering HRT include:

• intramuscular injection
 creams or gels
• vaginal rings
• tablets
• skin patches
Contraindication of HRT

HRT may not be suitable for women who have a history of:
• Uncontrolled hypertension, or high blood pressure
• Severe migraines
• Thrombosis or blood clots
• Stroke
• Heart disease
• Endometrial, ovarian or breast cancer.

In male
 Prostate cancer
 Uncontrolled heart failure
 Myocardial infraction or cerebrovascular accident within the past six months
 Haematocrit over 48 %
 Men planning fertility.

Side effect of HRT in female

 Bloating
 Breast tenderness or swelling
 Swelling in other part of the body
 Feeling sick
 Leg cramps
 Headache
 Indigestion
 Vaginal bleeding

Side effect of HRT in Male

• breast enlargement
• decreased testicle size
• worsening of existing sleep apnea
• increased cholesterol levels
• decreased sperm count
• infertility
• increased number of red blood cell

Long term side effect of HRT

Cardiovascular disease
Blood clots
Breast cancer
Headache
Hot flashes
Memory problem
Mood swings
Breast pain
Hair thinning
Stroke

Nursing implication

1) Prior to administration:
 Obtain complete history
• Family history
• Disease condition
• Drug allergy
2) During HRT
 Nurses must have current knowledge of hormonal replacement therapy to counsel the
patients .
 Monitor for thromboembolic disease and instruct client to report shortness of breath,chest
pain feeling of heaviness etc.
 Monitor for abnormal uterine bleeding and instruct client to report excessive bleeding
that may occur during menstruation .
 Unscheduled bleeding in first 6 months normal but it persisting beyond 6 months, rule
out other causes.
 Encourage to take HRT for 2 to 5 years to finish the symptoms of menopause.
 Monitor breast health and educate patient to have regular breast examination .
 Monitor the effectiveness by improvement in symptoms.
 Screening for mammography and cervical smear if not altered,to be continued.

3) Education
 Teach for exercise 30 minutes 5 times per week/ minimum of 3 times per week
 No smoking
 Maintain a normal blood pressure
 Maintain a normal weight.
 Eat a healthy diet.
 Remain mentally active.
 Prevent diabetes.
 Deal with depression.

References
 Mandal G.N(2010). A textbook of Adult Nursing. (5th ed), Makalu Publication House,
Kathmandu.
 Thapa U(2010 ).A textbook of Common Health Problems of Adulthood.(3rd ed).Makalu
Prsess P. Ltd, Dillibazar, Kathmandu.
 Hailes J, Hormone Replacement Therapy, Menopause, February 2018,Available on:
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hormone-
replacement-therapy-hrt-and-menopause
 Brazier Y, What do you mean by HRT, April 2020, Available on:
https://www.medicalnewstoday.com/articles/181726
 https//www.ncbi.nlm.nih.gov.